HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 18-00710 - ParkView Apartments Office ConversionC1 TY O F
1 E BURG
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BUILDING PERMIT FORM 220
Updated 03/2018
BUILDING APPLICATION
Commercial Electrical
Building Safety Department
City of Rexburg
35 North 15t East
Rexhura. Td;ihn R344n
For Office Use
Permit Number: _ Electrical Fees Paid ❑
1. Property Owner L -L C_
Name:_. s,�,� —6—
Address:
Address: IS'�f 3 1" ' r r ��_ City: _gexLLek g State: -_ Zip Code:
Phone:_ Email: 14 se 4.,_
2. Electrical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: G L State License #: 03(, / 7 _
A � Exp.: _
Address ��4 �, u, ( City: State: —J —_ Zip Code: rC3 k !�
Phone: _ ? C— if a_z, - '76 / /] Email: _
Contact/Rep. Name: _ Phone:
.�Op �fjZ tS/GEmail:
Electrical Contractor Authorized Signature: Date:(A -
A copy ofyourstate registration/license is required to be on file. Is is the first timeyou have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
Project Description
Address: 1 S-'f� S_ ".4 c.c__�
Description of work: C'�,=4 e t
❑ Project Cost: $
Cost of project:
Calculation for inspection fee:
if project cost is between $0 to $10,000 then:
(Cost of project * 296) + $60
if project cost is between $10,001 to $100,000 then:
((Cost of project - $10,000) * 1 %) + $260
If project cost is greater than $100001 then:
((Cost of project - $100,000) * % %) + $1160
i6i u will ul u ue u plan review jee totaling 10% of the above fee.
-- " „ v rw 1 nvtVeti I lu1V: unaer penalty of perjury, I hereby certify that l have read this application and state that the information herein
is correct and I swear that any information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall be truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012
International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print): QvrPysfsy Signature:
Date:��
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org
Permit Technician - (208) 372.2341